46D1080335 CLIA NUMBER - LIBERTY DIALYSIS - OGDEN

Laboratory Demographics

CLIA Number: 46D1080335

Facility Name: LIBERTY DIALYSIS - OGDEN

Facility Address:
4780 OLD POST RD
OGDEN, UT
ZIP 84403
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Facility Phone Number: 801 394-1230

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1225224066

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	46D1080335
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	LIBERTY DIALYSIS - OGDEN
Street	4780 OLD POST RD
City	OGDEN
State	UT
ZIP	84403
Phone	801 394-1230
CertificateType	4
CertificateEffectiveDate	11/1/2022
CertificateExpirationDate	10/31/2024
FacilityType	Waiver

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This page was last updated on: 4/23/2024